AHT 3 - Shock - ATI, Lewis, Evolve. MOD 1- Exam 1

As P.H.'s condition deteriorates, the health care provider determines the need to order IV methylprednisolone (Solu-Medrol). The patient's husband asks you how this drug will help his wife. Your best response is "This drug is a steroid that may help increase P.H.'s respiratory rate." "This drug is a corticosteroid that may help increase P.H.'s blood sugar." "This drug is a steroid that may help increase P.H.'s blood pressure." "This drug is a corticosteroid that may boost P.H.'s immune system."

"This drug is a steroid that may help increase P.H.'s respiratory rate." "This drug is a corticosteroid that may help increase P.H.'s blood sugar." "This drug is a steroid that may help increase P.H.'s blood pressure." - Correct! IV corticosteroids are only recommended for patients with septic shock who cannot maintain an adequate BP with vasopressor therapy, despite fluid resuscitation. "This drug is a corticosteroid that may boost P.H.'s immune system."

A client who is 30 minutes post op laparoscopic appendectomy has the following vital signs: blood pressure, 70/40; heart rate, 140 beats/min; respiratory rate, 25/min. The client is pale in color and it is difficult to find pedal pulses. Which action will the nurse take first? Begin intravenous fluids. Check the pulses with a Doppler device. Obtain a complete blood count (CBC). Obtain an electrocardiogram (ECG).

(CORRECT) Begin intravenous fluids. Check the pulses with a Doppler device. Obtain a complete blood count (CBC). Obtain an electrocardiogram (ECG).

A client is admitted to the medical surgical unit with dehydration from excessive vomiting secondary to acute pancreatitis. The nurse recognizes which clinical manifestation(s) as early sign(s) of hypovolemic shock? (Select all that apply.) Elevated heart rate Decreasing blood pressure Decreased respiratory rate Decreased pulse rate Decreased body temperature

(CORRECT) Elevated heart rate (CORRECT) Decreasing blood pressure Decreased respiratory rate Decreased pulse rate Decreased body temperature

A nurse in the emergency department is assessing a client who has internal injuries from a car crash. The client is disoriented to time and place, diaphoretic, and his lips are cyanotic. The nurse should anticipate which of the findings as an indication of hypovolemic shock?

(CORRECT) Increased heart rate - The nurse should anticipate an increased heart rate as an early indication of shock because the body attempts to compensate for decreased circulatory volume. Widening pulse pressure - The nurse should anticipate narrowing of the pulse pressure because systolic blood pressure and diastolic blood pressure increases. Increased deep tendon reflexes - The nurse should anticipate skeletal muscle changes, including decreased tendon reflexes. Pulse oximetry 96% - A pulse of 96% is within the expected reference range. The nurse should anticipate the pulse oximetry reading to be below 95%.

The nurse is caring for a 72-yr-old man in cardiogenic shock after an acute myocardial infarction. Which clinical manifestations would be most concerning?

(CORRECT) PaO2 of 38 mm Hg, serum lactate level of 46.5 mcg/dL, and puncture site bleeding - Severe hypoxemia, lactic acidosis, and bleeding are clinical manifestations of the irreversible state of shock. Recovery from this stage is not likely because of multiple organ system failure. Restlessness, tachycardia, and hypoactive bowel sounds are clinical manifestations that occur during the compensatory stage of shock. Decreased mean arterial pressure, jaundice, cold and clammy skin, agitation, tachypnea, and increased serum creatinine are clinical manifestations of the progressive stage of shock. Restlessness, heart rate of 124 beats/min, and hypoactive bowel sounds - Severe hypoxemia, lactic acidosis, and bleeding are clinical manifestations of the irreversible state of shock. Recovery from this stage is not likely because of multiple organ system failure. Restlessness, tachycardia, and hypoactive bowel sounds are clinical manifestations that occur during the compensatory stage of shock. Decreased mean arterial pressure, jaundice, cold and clammy skin, agitation, tachypnea, and increased serum creatinine are clinical manifestations of the progressive stage of shock. Agitation, respiratory rate of 32 breaths/min, and serum creatinine of 2.6 mg/dL - Severe hypoxemia, lactic acidosis, and bleeding are clinical manifestations of the irreversible state of shock. Recovery from this stage is not likely because of multiple organ system failure. Restlessness, tachycardia, and hypoactive bowel sounds are clinical manifestations that occur during the compensatory stage of shock. Decreased mean arterial pressure, jaundice, cold and clammy skin, agitation, tachypnea, and increased serum creatinine are clinical manifestations of the progressive stage of shock. Mean arterial pressure of 54 mm Hg; increased jaundice; and cold, clammy skin - Severe hypoxemia, lactic acidosis, and bleeding are clinical manifestations of the irreversible state of shock. Recovery from this stage is not likely because of multiple organ system failure.Restlessness, tachycardia, and hypoactive bowel sounds are clinical manifestations that occur during the compensatory stage of shock. Decreased mean arterial pressure, jaundice, cold and clammy skin, agitation, tachypnea, and increased serum creatinine are clinical manifestations of the progressive stage of shock.

You are working with unlicensed assistive personnel (UAP). Which nursing activity included in the care plan for a client with cirrhosis and esophageal varices is best delegated to the UAP? Reapply sequential compression devices following a bath. Assess hourly urine output. Administer subcutaneous insulin based on capillary blood glucose reading. Assess pain relief following administration of morphine.

(CORRECT) Reapply sequential compression devices following a bath. Assess hourly urine output. Administer subcutaneous insulin based on capillary blood glucose reading. Assess pain relief following administration of morphine.

Suspecting that P.H. may be septic, you consider the pathophysiology and clinical manifestations of shock. The underlying pathophysiologic process occurring in septic shock is related to a(n) _____________ of blood flow. Options: - decreased amount - maldistribution - increased rate

- maldistribution

Norepinephrine (Levophed) is available as 4 mg in 1000 mL 5% dextrose in water. The doctor ordered 8mcg/min until a MAP of 80 is reached. The nurse starts the infusion at which of the following rates? 2 mL/hr 8 mL/hr 60 mL/hr 120 mL/hr

2 mL/hr 8 mL/hr 60 mL/hr 120 mL/hr - Correct! Using the dosage calculation formula of D/H × C requires the following calculations: 4 mg = 4000 mcg (8 mcg/min ÷ 4000 mcg) × 1000 mL = 2 mL/min 2 mL/min × 60 min/hr = 120 mL/hr

Evolve online questions ch 66... 1. When caring for a patient in acute septic shock, what should the nurse anticipate? A. Infusing large amounts of IV fluids B. Administering osmotic and/or loop diuretics C. Administering IV diphenhydramine (Benadryl) D. Assisting with insertion of a ventricular assist device (VAD)

A Septic shock is characterized by a decreased circulating blood volume. Volume expansion with the administration of IV fluids is the cornerstone of therapy. The administration of diuretics is inappropriate. VADs are useful for cardiogenic shock not septic shock. Diphenhydramine (Benadryl) may be used for anaphylactic shock but would not be helpful with septic shock.)

Select all the complications that can arise from the progressive stage of shock: A. Acute respiratory distress syndrome B. Extreme edema C. Elevated ammonia and lactate levels D. GI bleeding and ulcers E. Dysrhythmias F. Myocardial infraction G. Acute tubular necrosis H. Disseminated intravascular clotting

A. Acute respiratory distress syndrome B. Extreme edema C. Elevated ammonia and lactate levels D. GI bleeding and ulcers E. Dysrhythmias F. Myocardial infraction G. Acute tubular necrosis H. Disseminated intravascular clotting - ALL options are correct. All these conditions can occur in the progressive stage of shock.

A nurse is caring for a client who is experiencing wheezing and swelling of the tongue. Which of the following medications should the nurse anticipate administering first? A. Methylprednisolone B. Diphenhydramine C. Epinephrine D. Dobutamine

A. Administer methylprednisolone to treat the inflammatory response. However, administer another medication first. B. Administer diphenhydramine to treat urticaria. However, administer another medication first. C. CORRECT: When using the airway, breathing, circulation approach to client care, place the priority on administering epinephrine to the client. This is a rapid‑acting medication that promotes effective oxygenation and is used to treat anaphylactic shock. D. Administer dobutamine or other medications to improve cardiac status if IV fluid replacement is not successful. However, administer another medication first.

ATI ch 37 shock... A nurse is caring for a client who has a prescription for an afterload‑reducing medication. The nurse should identify that this medication is administered for which of the following types of shock? A. Cardiogenic B. Obstructive C. Hypovolemic D. Distributive

A. CORRECT: Identify that a prescription to reduce afterload will allow the heart to pump more effectively, which is needed for the client who has cardiogenic shock. B. I n obstructive shock, the high afterload is due to obstruction of blood flow. Afterload‑reducing agents will not remove the obstruction. C. Fluid replacement and reduction of further fluid loss are the focus of management of hypovolemic shock. D. Afterload‑reducing medication is not administered to a client who has distributive shock because the client already has decreased afterload.

When the body is attempting to compensate for shock the adrenal cortex will release aldosterone due to the presence of angiotensin II. Select all the effects aldosterone will have on the body in attempt to increase cardiac output and maintain tissue perfusion: A. Increase blood volume B. Causes the kidneys to keep sodium and water C. Causes the kidneys to excrete sodium and water D. Cause the urine to have a low osmolality

A. Increase blood volume B. Causes the kidneys to keep sodium and water - The answers are A and B. Aldosterone will be released due to the presence of angiotensin II in the body (this is from the kidneys activating the renin-angiotensin system, which will cause major vasoconstriction in hopes of increasing blood pressure and cardiac output and hopefully perfusion to the kidneys). Aldosterone functions to cause the kidneys to KEEP sodium and water, which will INCREASE the blood volume. This will in turn increase the blood return to the heart and increase cardiac output. Because there will be a high amount of sodium in the urine, this will lead the urine to have a HIGH osmolality, which will cause the posterior pituitary gland to release ADH (anti-diuretic hormone). ADH will further cause the kidneys to keep water....in hopes of increasing blood volume even more.

A nurse is planning care for a client who has septic shock. Which of the following actions is the priority for the nurse to take? A. Maintain adequate fluid volume with IV infusions. B. Administer antibiotic therapy. C. Monitor hemodynamic status. D. Administer vasopressor medication.

A. Maintain the client's fluid volume by administration of IV fluids. However, another action is the priority. B. CORRECT: The greatest risk to the client is injury from elimination endotoxins and mediators from bacteria. The priority intervention is to administer antibiotics, which will reduce vasodilation. C. Monitor hemodynamic status to monitor the blood pressure inside the veins, arteries and heart. However, another action is the priority. D. Administer vasopressor medication to increase the contractility of the heart muscle and to cause vasoconstriction. However, another action is the priority.

A nurse in the emergency department is completing an assessment on a client who is in shock. Which of the following findings should the nurse expect? (Select all that apply.) A. Heart rate 60/min B. Seizure activity C. Respiratory rate 42/min D. Increased urine output E. Weak, thready pulse

A. Tachycardia is an expected finding in a client who is in shock. B. CORRECT: Seizure activity caused by progressive hypoxia can be present in a client who is in shock. C. CORRECT: Tachypnea is an expected finding in a client who is in shock due to the body's attempt to increase oxygen intake. D. D ecreased urine output is in expected finding in a client who is in shock. E. CORRECT: A weak, thready pulse caused by low fluid volume, vasoconstriction, and hypotension is an expected finding in a client who is in shock.

...ATI ch 37 A nurse is caring for a group of clients. Which of the following clients is at risk for obstructive shock? A. A client who is having occasional PVCs on the ECG monitor B. A client who has been experiencing vomiting and diarrhea for several days C. A client who has a gram-negative bacterial infection D. A client who has a pulmonary arterial stenosis

A. Ventricular dysrhythmia is a risk factor for cardiogenic shock. B. D ehydration from vomiting and diarrhea for several days is a risk factor for hypovolemic shock. C. Presence of a gram-negative bacterial infection is a risk factor for septic shock. D. CORRECT: Obstructive shock results from decreased cardiac function by a noncardiac cause, such as with pulmonary arterial stenosis or hypertension, or thoracic tumor.

A nurse in an emergency department is caring for a client who has anaphylaxis following a bee sting. Which of the following actions should the nurse take first?

Assess the client's level of consciousness. - The nurse should assess and monitor the client's level of consciousness as anaphylaxis causes widespread vasodilation and anaphylactic shock may develop. However, this is not the priority intervention action when taking the airway, breathing, circulation (ABC) approach to client care. Administer epinephrine. - The nurse should administer epinephrine as this medication causes vasoconstriction, bronchodilation, and improves cardiac output. However, this is not the priority action when taking the airway, breathing, circulation (ABC) approach to client care. (CORRECT) Auscultate for wheezing. - When using the airway, breathing, circulation approach to client care, the nurse should place the priority on assessing the client's respiratory status. Bronchoconstriction or closure of the upper airway may occur, which places the client at risk for respiratory arrest. Monitor for hypotension. - The nurse should monitor for hypotension because the anaphylactic reaction causes systemic vasodilation placing the client at risk for hypovolemic shock. However, another action is the priority when taking the airway, breathing, circulation (ABC) approach to client care.

3. A 50-year-old woman with a suspected brain tumor is scheduled for a computed tomography (CT) scan with contrast media. The nurse notifies the physician that the patient reported an allergy to shellfish. Which response by the physician should the nurse question? A. Infuse IV diphenhydramine prior to the procedure. B. Administer lorazepam (Ativan) before the procedure. C. Complete the CT scan without the use of contrast media. D. Premedicate with hydrocortisone sodium succinate (Solu-Cortef).

B An individual with an allergy to shellfish is at an increased risk to develop anaphylactic shock if contrast media is injected for a CT scan. To prevent anaphylactic shock, the nurse should always confirm the patient's allergies before diagnostic procedures (e.g., CT scan with contrast media). Appropriate interventions may include cancelling the procedure, completing the procedure without contrast media, or premedication with diphenhydramine or hydrocortisone. IV fluids may be given to promote renal clearance of the contrast media and prevent renal toxicity and acute kidney injury. The use of an antianxiety agent such as lorazepam would not be effective in preventing an allergic reaction to the contrast media.)

2. When caring for a critically ill patient who is being mechanically ventilated, the nurse will astutely monitor for which clinical manifestation of multiple organ dysfunction syndrome (MODS)? A. Increased serum albumin B. Decreased respiratory compliance C. Increased gastrointestinal (GI) motility D. Decreased blood urea nitrogen (BUN)/creatinine ratio

B Clinical manifestations of MODS include symptoms of respiratory distress, signs and symptoms of decreased renal perfusion, decreased serum albumin and prealbumin, decreased GI motility, acute neurologic changes, myocardial dysfunction, disseminated intravascular coagulation (DIC), and changes in glucose metabolism.)

2. A 64-year-old woman is admitted to the emergency department vomiting bright red blood. The patient's vital signs are blood pressure 78/58 mm Hg, pulse 124 beats/minute, respirations 28 breaths/minute, and temperature 97.2° F (36.2° C). Which physician order should the nurse complete first? A. Obtain a 12-lead ECG and arterial blood gases. B. Rapidly administer 1000 mL normal saline solution IV. C. Administer norepinephrine (Levophed) by continuous IV infusion. D. Carefully insert a nasogastric tube and an indwelling bladder catheter.

B Isotonic crystalloids, such as normal saline solution, should be used in the initial resuscitation of hypovolemic shock. Vasopressor drugs (e.g., norepinephrine) may be considered if the patient does not respond to fluid resuscitation and blood products. Other orders (e.g., insertion of nasogastric tube and indwelling bladder catheter and obtaining the diagnostic studies) can be initiated after fluid resuscitation is initiated.)

6. The nurse would recognize which clinical manifestation as suggestive of sepsis? A. Sudden diuresis unrelated to drug therapy B. Hyperglycemia in the absence of diabetes C. Respiratory rate of seven breaths per minute D. Bradycardia with sudden increase in blood pressure

B Hyperglycemia in patients with no history of diabetes is a diagnostic criterion for sepsis. Oliguria, not diuresis, typically accompanies sepsis along with tachypnea and tachycardia.)

A patient is in hypovolemic shock. Select all the stages that a patient can enter when in shock: A. Proliferative B. Compensatory C. Exudative D. Initial E. Progressive F. Fibrotic G. Refractory

B. Compensatory D. Initial E. Progressive G. Refractory

During the __________ stage of shock, the signs and symptoms are very subtle. However, cells are experiencing _________ due to the lack of tissue perfusion, which causes the cells to switch from ___________ metabolism to _________ metabolism. A. Proliferative, hyperoxia, anaerobic, aerobic B. Initial, hypoxia, aerobic, anaerobic C. Compensatory, hypoxia, anaerobic, aerobic D. Fibrotic, hypoxia, aerobic, anaerobic

B. Initial, hypoxia, aerobic, anaerobic - The answer is B. During the INITIAL stage of shock, the signs and symptoms are very subtle. However, cells are experiencing HYPOXIA (low oxygen), which causes the cells to switch from AEROBIC (with oxygen) metabolism to ANAEROBIC (without oxygen....there is none to really use) metabolism. This will produce a waste product called LACTIC ACID.

1. The nurse is caring for a 72-year-old man in cardiogenic shock after an acute myocardial infarction. Which clinical manifestations would be of most concern to the nurse? A. Restlessness, heart rate of 124 beats/minute, and hypoactive bowel sounds B. Mean arterial pressure of 54 mm Hg, increased jaundice, and cold, clammy skin C. PaO2 of 38 mm Hg, serum lactate level of 46.5 mcg/dL, and bleeding from puncture sites D. Agitation, respiratory rate of 32 breaths/minute, and serum creatinine level of 2.6 mg/dL

C Severe hypoxemia, lactic acidosis, and bleeding are clinical manifestations of the irreversible state of shock. Recovery from this stage is not likely because of multiple organ system failure. Restlessness, tachycardia, and hypoactive bowel sounds are clinical manifestations that occur during the compensatory stage of shock. Decreased mean arterial pressure, jaundice, cold/ clammy skin, agitation, tachypnea, and increased serum creatinine are clinical manifestations of the progressive stage of shock.)

5. A patient's localized infection has progressed to the point where septic shock is now suspected. What medication is an appropriate treatment modality for this patient? A. Insulin infusion B. IV administration of epinephrine C. Aggressive IV crystalloid fluid resuscitation D. Administration of nitrates and β-adrenergic blockers

C Patients in septic shock require large amounts of crystalloid fluid replacement. Nitrates and β-adrenergic blockers are most often used in the treatment of patients in cardiogenic shock. Epinephrine is indicated in anaphylactic shock, and insulin infusion is not normally necessary in the treatment of septic shock (but can be).)

4. The nurse is caring for a 29-year-old man who was admitted a week ago with multiple rib fractures, a pulmonary contusion, and a left femur fracture from a motor vehicle crash. After the attending physician tells the family that the patient has developed sepsis, the family members have many questions. Which information should the nurse include in explaining the early stage of sepsis? A. Antibiotics are not useful once an infection has progressed to sepsis. B. Weaning the patient away from the ventilator is the top priority in sepsis. C. Large amounts of IV fluid are required in sepsis to fill dilated blood vessels. D. The patient has recovered from sepsis if he has warm skin and ruddy cheeks.

C Patients with sepsis may be normovolemic but because of acute vasodilation, relative hypovolemia and hypotension occur. Patients in septic shock require large amounts of fluid replacement and may require frequent fluid boluses to maintain circulation. Antibiotics are an important component of therapy for patients with septic shock. They should be started after cultures (e.g., blood, urine) are obtained and within the first hour of septic shock. Oxygenating the tissues is the top priority in sepsis, so efforts to wean septic patients from mechanical ventilation halt until sepsis is resolving. Addititonal respiratory support may be needed during sepsis. Although cool and clammy skin is present in other early shock states, the patient in early septic shock may feel warm and flushed because of a hyperdynamic state.)

Which statements are INCORRECT about the compensatory stage of shock. Select all that apply: A. This stage is reversible. B. During this stage blood is shunted away from the kidneys, lungs, skin, and gastrointestinal system to the brain and heart. C. During this stage blood flow to the kidneys is reduced, which causes the kidneys to activate the renin-angiotensin system, and this will lead to major vasodilation to the arterial and venous system. D. One hallmark sign of this stage is that there is an increase in capillary permeability. E. A patient is at risk for a paralytic ileus during this stage.

C. During this stage blood flow to the kidneys is reduced, which causes the kidneys to activate the renin-angiotensin system, and this will lead to major vasodilation to the arterial and venous system. D. One hallmark sign of this stage is that there is an increase in capillary permeability. - The answers are: C and D. These options reflect INCORRECT statements about the compensatory stages and all the other stages are TRUE about this stage. Option C is wrong because although the kidneys activate the RAS, this does NOT lead to vasodilation but VASOCONSTRICTION to the arterial and venous system. Option D is wrong because this is a hallmark sign in the PROGRESSIVE stage not compensatory.

Based on this scenario, what stage of shock is this patient most likely experiencing: A 74-year-old patient is extremely confused and does not respond to commands or stimulation. The patient respiratory rate is 28 and labored, oxygen saturation 86%, heart rate 120, blood pressure 70/40, mean arterial pressure is 50 mmHg, and temperature is 97 'F. The patient's heart rhythm is atrial fibrillation. The patient's urinary output is 5 mL/hr. The patient's labs: blood pH 7.15, serum lactate 15 mmol/L, BUN 55 mg/dL, Creatinine 6 mg/dL. In addition, the patient is now starting to have slight oozing of blood around puncture sites. A. Initial B. Proliferative C. Progressive D. Compensatory

C. Progressive - The answer is C. This is the progressive stage. There are four stages of shock (in order): initial, compensatory, progressive, and refractory. The patient's body is experiencing major signs and symptoms of shock. This is not found in the initial stage of shock because the signs and symptoms are subtle. During the compensatory stage, the body (for a while) can compensate so major organs are not showing major signs and symptoms of failure as they are in this scenario (the kidneys are starting to fail based on the BUN, creatinine, urinary output). In addition, the body is no longer compensating because the blood pressure is very low along with the MAP (mean arterial pressure). A big sign is that the patient's mental status is altered. This represents that the brain is not being perfused very well. The MAP should be 60 or greater to provide adequate perfusion. The MAP here is 50 and this shows us the body is NOT perfusing the organs, so the cells will experience hypoxic injury. The patient is also starting to show early signs and symptoms of DIC due to the slight oozing of blood around puncture sites. The next stage (which is the last) is the refractory and this is where organs have failed or are about too. Death is imminent. This patient is not at that point but is getting close. This patient needs very dynamic treatment in order to survive.

You're caring for a patient who is experiencing shock. Which lab result below demonstrates that the patient's cells are using anaerobic metabolism? A. Ammonia 18 µ/dL B. Potassium 4.5 mEq/L C. Serum Lactate 9 mmol/L D. Bicarbonate 23 mEq/L

C. Serum Lactate 9 mmol/L - The answer is C. A patient who is in shock will experience anaerobic metabolism because the cells can no longer use oxygen for energy due to the loss of tissue perfusion. Remember in shock, the cardiac output is too low to perfuse the cells of the organs and tissue. Therefore, the cells try to compensate by switching from aerobic metabolism to anaerobic, BUT this type of metabolism creates a waste-product called LACTIC ACID. A normal serum lactate is <1 mmol/L and lactic acidosis is >4 mmol/L.

A nurse is caring for a client who is experiencing hypovolemic shock. Which of the following blood products should the nurse anticipate administering to this client?

Cryoprecipitates - Cryoprecipitates are administered to clients who have hemophilia or von Willebrand disease. Platelets - Platelets are administered to clients who have thrombocytopenia. Albumin - Albumin is administered to clients who have hypoproteinemia and burns. (CORRECT) Packed RBCs - Packed RBCs are given to restore blood volume and replace hematocrit and hemoglobin levels in clients who have hypovolemic shock.

7. Following coronary artery bypass graft surgery a patient has postoperative bleeding that requires returning to surgery to repair the leak. During surgery, the patient has a myocardial infarction (MI). After restoring the patient's body temperature to normal, which patient assessment is the most important for planning nursing care? A. Cardiac index (CI) 5 L/min/m2 B. Central venous pressure 8 mm Hg C. Mean arterial pressure (MAP) 86 mm Hg D. Pulmonary artery pressure (PAP) 28/14 mm Hg

D Pulmonary hypertension as indicated by an elevated PAP indicates impaired forward flow of blood because of left ventricular dysfunction or hypoxemia. Both can be due to the MI. The CI, CVP, and MAP readings are normal.)

...Evolve online questions ch 66 5. The nurse is assisting in the care of several patients in the critical care unit. Which patient is at greatest risk for developing multiple organ dysfunction syndrome (MODS)? A. 22-year-old patient with systemic lupus erythematosus who is admitted with a pelvic fracture after a motor vehicle accident B. 48-year-old patient with lung cancer who is admitted for syndrome of inappropriate antidiuretic hormone and hyponatremia C. 65-year-old patient with coronary artery disease, dyslipidemia, and primary hypertension who is admitted for unstable angina D. 82-year-old patient with type 2 diabetes mellitus and chronic kidney disease who is admitted for peritonitis related to a peritoneal dialysis catheter infection

D A patient with peritonitis is at high risk for developing sepsis. In addition, a patient with diabetes is at high risk for infections and impaired healing. Sepsis and septic shock are the most common causes of MODS. Individuals at greatest risk for developing MODS are older adults and persons with significant tissue injury or preexisting disease. MODS can be initiated by any severe injury or disease process that activates a massive systemic inflammatory response.)

3. A massive gastrointestinal bleed has resulted in hypovolemic shock in an older patient. What is a priority nursing diagnosis? A. Acute pain B. Impaired tissue integrity C. Decreased cardiac output D. Ineffective tissue perfusion

D The many deleterious effects of shock are all related to inadequate perfusion and oxygenation of every body system. This nursing diagnosis supersedes the other diagnoses.)

4. What laboratory finding fits with a medical diagnosis of cardiogenic shock? A. Decreased liver enzymes B. Increased white blood cells C. Decreased red blood cells, hemoglobin, and hematocrit D. Increased blood urea nitrogen (BUN) and serum creatinine levels

D The renal hypoperfusion that accompanies cardiogenic shock results in increased BUN and creatinine levels. Impaired perfusion of the liver results in increased liver enzymes, while white blood cell levels do not typically increase in cardiogenic shock. Red blood cell indices are typically normal because of relative hypovolemia.)

During what stage of shock is the body unable to compensate for tissue perfusion and the body's cell start to experience hypoxic injury that result in __________capillary permeability? A. Refractory, increased B. Exudative, decreased C. Compensatory, increased D. Progressive, increased

D. Progressive, increased - The answer is D. During the progressive stage of shock, the body can NOT compensate any longer by utilizing the neural, hormonal and biochemical responses of the body as it did in the previous stage (compensatory). Therefore, the cells are NO longer perfused due to extremely low cardiac output. When the cells are no longer perfused they can't survive, so they experience HYPOXIC injury, and this results in INCREASED capillary permeability. The cell's ion pump will fail and lead to cell swelling and death. All the organs (due to the death of their cells) will begin to fail, and if very dynamic treatment is not implemented the patient will enter the last stage of shock, which is the refractory stage. This stage is irreversible.

During shock, when a patient experiences a drop in cardiac output, the body tries to compensate by stimulating the sympathetic nervous system, which causes the release of _________ and ________. This will lead to? A. acetylcholine and dopamine, vasodilation B. epinephrine and norepinephrine, vasodilation C. dopamine and epinephrine, vasoconstriction D. norepinephrine and epinephrine, vasoconstriction

D. norepinephrine and epinephrine, vasoconstriction - The answer is D. When a patient in shock experiences a drop in blood pressure (due to a drop in cardiac output), the baroreceptors (in the carotid and aortic arch) will sense this and stimulate the sympathetic nervous system. The SNS will release the neurotransmitters NOREPINEPHRINE and EPINEPRHINE and this will lead to VASOCONSTRICTION. By causing constriction of the vessels, it will temporarily increase cardiac output by increase the blood pressure and heart rate, which will in turn increase perfusion to cells.

For which manifestation will the nurse monitor when caring for the client with anaphylactic shock resulting from exposure to CT contrast? Decreased heart rate and blood pressure Increased blood pressure and cardiac output Decreased blood pressure and respiratory rate Edema and shortness of breath

Decreased heart rate and blood pressure Increased blood pressure and cardiac output Decreased blood pressure and respiratory rate (CORRECT) Edema and shortness of breath

TRUE or FALSE: All types of shock during the compensatory (early) stage will cause a patient to experience cold and clammy (moist or sweaty) skin. True False

False - FALSE: Patients who have septic shock will actually experience warm and flushed skin during the early (compensatory stage) because of the vasodilation occurring with this type of shock. The other types of shock will have cold and clammy (sweaty) skin due to decreased perfusion to the skin.

What is most important to complete before giving the ceftriaxone? (after checking for allergies)

Hydrate with at least 1 L of NSS. Administer oxygen via nasal cannula. Document history and physical findings. (CORRECT) Obtain blood, urine, and sputum specimens for culture. - Because sepsis is caused by an infectious microorganism, antibiotics are an important and early component of therapy. They should be started within the first hour of septic shock. Obtain cultures (e.g., blood, wound exudate, urine, stool, sputum) before antibiotics are started to get the most accurate results. However, these activities should not delay the start of antibiotics within the first hour.

In monitoring a client with pneumonia and septic shock who has been placed on a vasopressor IV infusion, the nurse recognizes which parameter as the desired response to this drug? Hypotension Tachycardia Increased cardiac output Decreased mean arterial pressure

Hypotension Tachycardia (CORRECT) Increased cardiac output Decreased mean arterial pressure

A nurse ia caring for a client at risk for shock. Which of the following findings is the earliest indicator that this complication is developing?

Hypotension - In the first stage of shock, the body is able to maintain homeostasis and blood pressure remains within normal limits. A slight increase in diastolic blood pressure may be noted. Anuria - In the compensatory (initial) stage of shock vasoconstriction and the shunting of blood supports the vital organs, the heart, brain, and lungs. Decreased perfusion to the kidneys along with the release of aldosterone and ADH results in a decrease in urine output. Anuria occurs in the last, or irreversible, stage of shock. (CORRECT) Narrowing pulse pressure - Pulse pressure is the difference between the systolic and diastolic blood pressures. In the initial stage of shock there is a slight increase in the diastolic blood pressure, which narrows the pulse pressure. Decreased level of consciousness - The client who is in the compensatory stage of shock may feel anxious or confused. As shock progresses the client becomes lethargic and finally becomes unconscious in the irreversible stage.

A patient admitted with a GI bleed and history of heart failure is receiving IV fluid therapy. You prioritize assessment for which complication during this period? Infection Contractures Pulmonary Edema Compartment syndrome

Infection Contractures (CORRECT) Pulmonary Edema Compartment syndrome

A 50-yr-old woman with a suspected brain tumor is scheduled for a CT scan with contrast media. The nurse notifies the physician that the patient reported an allergy to shellfish. Which response by the physician should the nurse question?

Infuse IV diphenhydramine before the procedure. - An individual with an allergy to shellfish is at an increased risk to develop anaphylactic shock if contrast media is injected for a CT scan. To prevent anaphylactic shock, the nurse should always confirm the patient's allergies before diagnostic procedures (e.g., CT scan with contrast media). Appropriate interventions may include cancelling the procedure, completing the procedure without contrast media, or premedication with diphenhydramine or hydrocortisone. IV fluids may be given to promote renal clearance of the contrast media and prevent renal toxicity and acute kidney injury. The use of an antianxiety agent such as lorazepam would not be effective in preventing an allergic reaction to the contrast media. Premedicate with hydrocortisone sodium succinate (Solu-Cortef). - An individual with an allergy to shellfish is at an increased risk to develop anaphylactic shock if contrast media is injected for a CT scan. To prevent anaphylactic shock, the nurse should always confirm the patient's allergies before diagnostic procedures (e.g., CT scan with contrast media). Appropriate interventions may include cancelling the procedure, completing the procedure without contrast media, or premedication with diphenhydramine or hydrocortisone. IV fluids may be given to promote renal clearance of the contrast media and prevent renal toxicity and acute kidney injury. The use of an antianxiety agent such as lorazepam would not be effective in preventing an allergic reaction to the contrast media. Complete the CT scan without the use of contrast media. - An individual with an allergy to shellfish is at an increased risk to develop anaphylactic shock if contrast media is injected for a CT scan. To prevent anaphylactic shock, the nurse should always confirm the patient's allergies before diagnostic procedures (e.g., CT scan with contrast media). Appropriate interventions may include cancelling the procedure, completing the procedure without contrast media, or premedication with diphenhydramine or hydrocortisone. IV fluids may be given to promote renal clearance of the contrast media and prevent renal toxicity and acute kidney injury. The use of an antianxiety agent such as lorazepam would not be effective in preventing an allergic reaction to the contrast media. (CORRECT) Administer lorazepam (Ativan) before the procedure. - An individual with an allergy to shellfish is at an increased risk to develop anaphylactic shock if contrast media is injected for a CT scan. To prevent anaphylactic shock, the nurse should always confirm the patient's allergies before diagnostic procedures (e.g., CT scan with contrast media). Appropriate interventions may include cancelling the procedure, completing the procedure without contrast media, or premedication with diphenhydramine or hydrocortisone. IV fluids may be given to promote renal clearance of the contrast media and prevent renal toxicity and acute kidney injury. The use of an antianxiety agent such as lorazepam would not be effective in preventing an allergic reaction to the contrast media.

A nurse is caring for a client who is in the compensatory stage of shock. Which of the following findings should the nurse expect?

Mottled skin - Shock progresses along a continuum beginning with the compensatory stage, in which the body is still able to maintain hemodynamic stability. Vasoconstriction and shunting of blood ensures perfusion to vital organs. However, the skin becomes cool, pale, and diaphoretic. As shock progresses into the progressive stage, the skin begins to mottle. (CORRECT) Blood pressure 115/68 mmHg - The sympathetic nervous system is stimulated, resulting in the release of epinephrine and norepinephrine. These catecholamines help maintain the client's blood pressure remains within normal limits during the compensatory stage of shock. Heart rate 160/min - During the compensatory stage of shock, the heart and blood pressure generally remain only slightly altered. A heart rate of 100-150/min with only a slight increase in diastolic blood pressure is seen in this stage. Hypokalemia - The nurse should expect possible hyperkalemia, which is mild during compensatory (nonprogressive) shock, and worsens in later stages.

Which findings reflect the compensatory stage of septic shock? There are 5 correct answers. Skin warm and flushed Tachycardia Soft, nontender abdomen Delayed capillary refill Hyperventilation Hypoactive bowel sounds Lethargy Restlessness Decreased urine output

Skin warm and flushed Tachycardia Hyperventilation Hypoactive bowel sounds Restlessness

A client brought to the intensive care unit (ICU) after a fall on anticoagulants is suspected of having internal bleeding. Which of the following clinical manifestations would alert the nurse to early hypovolemic shock onset? Slowed respiratory rate Lack of urinary output Increased heart rate Necrotic extermities

Slowed respiratory rate Lack of urinary output (CORRECT) Increased heart rate Necrotic extermities

During what stage of shock does the body attempt to utilize the hormonal, neural, and biochemical responses of the body? A. Refractory B. Initial C. Proliferative D. Compensatory

The answer is D: the compensatory stage

When reviewing assessment data, you identify the presence of septic shock when P.H.'s systolic BP remains (high/low) despite fluid (resuscitation/restriction). A laboratory result corroborating this diagnosis would be a (creatinine/lactate) level greater than 36 mg/dL (94 mmol/L).

When reviewing assessment data, you identify the presence of septic shock when P.H.'s systolic BP remains low despite fluid resuscitation. A laboratory result corroborating this diagnosis would be a lactate level greater than 36 mg/dL (94 mmol/L).

When assessing a patient in shock, the nurse recognizes that the hemodynamics of shock include a normal cardiac output in cardiogenic shock. an increase in central venous pressure in hypovolemic shock. a continuous increase in systemic vascular resistance in all types of shock. variations in cardiac output and decreased systemic vascular resistance in septic shock.

a normal cardiac output in cardiogenic shock. an increase in central venous pressure in hypovolemic shock. a continuous increase in systemic vascular resistance in all types of shock. (CORRECT) variations in cardiac output and decreased systemic vascular resistance in septic shock.

Appropriate treatment modalities for the management of cardiogenic shock include (select all that apply) a. dobutamine to increase myocardial contractility. b. vasopressors to increase systemic vascular resistance. c. circulatory assist devices such as an intraaortic balloon pump. d. corticosteroids to stabilize the cell wall in the infarcted myocardium. e. Trendelenburg positioning to facilitate venous return and increase preload.

a. dobutamine to increase myocardial contractility. c. circulatory assist devices such as an intraaortic balloon pump.

A 78-year-old man has confusion and temperature of 104° F (40° C). He is a diabetic with purulent drainage from his right heel. After an infusion of 3 L of normal saline solution, his assessment findings are BP 84/40 mm Hg; heart rate 110; respiratory rate 42 and shallow; CO 8 L/minute; and PAWP 4 mm Hg. This patient's symptoms are most likely indicative of a. sepsis. b. septic shock. c. multiple organ dysfunction syndrome. d. systemic inflammatory response syndrome.

b. septic shock.

...Lewis Bridge to NCLEX The most accurate assessment parameters for the nurse to use to determine adequate tissue perfusion in the patient with MODS are a. blood pressure, pulse, and respirations. b. breath sounds, blood pressure, and body temperature. c. pulse pressure, level of consciousness, and pupillary response. d. level of consciousness, urine output, and skin color and temperature.

d. level of consciousness, urine output, and skin color and temperature.

Lewis Bridge to NCLEX... A patient has a spinal cord injury at T4. Vital signs include falling blood pressure with bradycardia. The nurse recognizes that the patient is experiencing a. a relative hypervolemia. b. an absolute hypovolemia. c. neurogenic shock from low blood flow. d. neurogenic shock from massive vasodilation.

d. neurogenic shock from massive vasodilation.

Types of Shock s/s

https://www.grepmed.com/images/4224/types-table-signs-classification-symptoms

Types of Shock NCLEX

https://www.studypk.com/articles/types-shock-cheat-sheet/